PENN BIOGRAPHIES

Benjamin
Rush (1746-1813)

Professor of the Institutes of Medicine and Clinical Practice,
1791-1813

Biographical Summary:

Vice President of American Philosophical Society

Member of Second Continental Congress and Signer of the Declaration
of Independence

Surgeon General of the Middle Department of the Continental Army

One of the founders of the College of Physicians

"Father of American Psychiatry"

Benjamin Rush was born on January 4, 1746 in Byberry Township, Pennsylvania,
the son of John Rush, a farmer and gunsmith, and Susanna Hall Harvey.
After his father's death in 1751, his mother moved to Philadelphia,
where she ran a grocery store to support the family. At the age of eight,
Rush was sent to live with his uncle, Rev. Dr. Samuel Finley. Finley,
a pastor and headmaster of Nottingham Academy, saw to it that Rush received
an education. Rush entered the College of New Jersey (now Princeton)
in 1759, receiving an A.B. in 1760, at the age of fourteen.

On returning to Philadelphia, Rush came into contact with some of the
most prominent American physicians of the time. From 1761 to 1766, he
apprenticed under John Redman and attended
the first lectures of John Morgan and
William Shippen, Jr. at the newly founded
department of medicine in the College of Philadelphia. During these years, Rush also began his lifelong habit of regularly
making entries in his Commonplace Book, including notes that
later afforded the only written eyewitness account of the 1762 yellow
fever epidemic in Philadelphia.

In 1766, at Redman's urging, Rush left North America to study at the
University of Edinburgh, then one of the most renowned medical schools
in Europe. While there, he became the disciple and friend of the highly
respected William Cullen, who profoundly influenced Rush's theoretical
approach to medicine. His thesis, "On the Digestion of Food in
the Stomach", reflected his training in chemistry and was based
in part on self-experimentation. After receiving his medical degree
in 1768, Rush spent several months training at St. Thomas's Hospital
in London, where he had the opportunity to attend dissections by William
Hunter and to meet Benjamin Franklin, who was then in London. Franklin
persuaded Rush to take a trip to France in early 1769, which he partially
financed and which gave Rush the opportunity to meet French physicians,
scientists, and literati. While abroad, Rush was elected to the American
Philosophical Society back in Philadelphia and later served as its vice
president.

On
his return to Philadelphia in the summer of 1769, Rush immediately began
his practice, having studied medicine for nine years. Because he had
few contacts among the well-to-do, he treated mainly the poor. On August
1, 1769, Rush was appointed Professor of Chemistry in Penn's medical department. The
following year, Rush published A Syllabus of a Course of Lectures
on Chemistry, the first American text on the subject.

On July 20, 1776, the Constitutional Convention of Pennsylvania voted
to send a less conservative delegation, which included Rush, to represent
Pennsylvania in Congress. Rush took his seat in the Second Continental
Congress on July 22, and signed the Declaration of Independence on August
2. He was the only signer holding a medical degree.

In April 1777, Rush was commissioned Surgeon General of the Middle
Department of the Continental Army. It was not long before Rush became
outraged at the disorganization and corruption plaguing army hospitals.
He repeatedly expressed his dissatisfaction with the situation to his
superiors, and later to their superiors and to Congress. In January
1778, Rush resigned from the army, following a series of events stemming
from an unsigned letter to Governor Patrick Henry of Virginia that General
George Washington attributed to Rush and considered evidence of disloyalty.

Disillusioned, Rush soon resumed his practice and professorship in
Philadelphia, turning his attention almost exclusively to medicine.
In 1780, he began lecturing at the newly established University of the
State of Pennsylvania. He served as surgeon at the Pennsylvania Hospital
from 1784 until his death. While there, he assumed responsibility for
the patients in the psychiatric ward and began advocating changes to
humanize psychiatric treatment in American hospitals. In 1786, Rush
set up the Philadelphia Dispensary to provide medical care for the poor,
the first such institution in the United States and likely modeled on
dispensaries that Rush had seen in London.

Rush expressed a firm commitment to promoting higher education. He
was a founder of Dickinson College in Carlisle, Pennsylvania in 1783
and Franklin College (now Franklin and Marshall) at Lancaster four years
later. In 1787, Rush helped found the College of Physicians. He proposed
a national system of public education with a federal university to train
public servants and favored the education of women. He also helped to
establish and finance the oldest Negro church in the country.

Rush returned to politics in 1787, when he was elected to the Pennsylvania
ratifying convention for the new federal Constitution. He and James
Wilson led the movement for adoption. Two years later, the same men
mounted a successful campaign to make over the Pennsylvania constitution,
Rush's last involvement in state or national politics.

In 1789, the Trustees of the College elected Rush Professor of Theory
and Practice of Medicine. In 1791, when the College merged with
the University of the State of Pennsylvania to become the University
of Pennsylvania, Rush held the chair of the Institutes of Medicine and
Clinical Practice. He assumed the chair of Theory and Practice of Medicine
there in 1796.

The conceptual foundation of Rush's medical practice drew on the system
of Cullen and John Brown, a fellow physician who had studied under Cullen
with Rush at Edinburgh. Whereas traditional medicine had based diagnosis
and treatment largely on changes in balance among the bodily humors,
Cullen emphasized nervous energy and stimulation of the nervous system,
believing disease to be caused by either excessive or inadequate nervous
stimulation. Thus, excess stimulation required therapeutic depletion
by purging or bloodletting, whereas a deficit called for stimulation
from diet or brandy. Rush's own unitary theory of disease held that
the "excited" nervous state characterizing all life had only
two forms: healthy and morbid. Morbid excitement from convulsive action
in the blood vessels, which caused symptoms ranging from fever to insanity,
required immediate depletion to restore the body's balance.

Rush's therapeutic theories were severely tested during the Philadelphia
yellow fever epidemic of 1793, which struck harder than any of the six
such epidemics before it. From early August until November of that year,
it claimed the lives of between 4000 and 5000 residents of Philadelphia,
or about one-tenth of the population. As the epidemic worsened, Rush
grew desperate, for nothing he tried seemed to work. In late August,
he happened to reread a 1744 manuscript written by John Mitchell, a
Scottish physician who had experienced the 1741 yellow fever epidemic
in Virginia and who recommended strong purges for even the weakest patients.
Rush began "depletion" treatments accordingly, administrating
heavy doses of purgatives complemented with bloodletting and applications
of cold water. He found his system highly effective, especially when
employed early. Rush himself fell ill with fever twice during the epidemic,
but recovered quickly after applying his treatment.

When the epidemic lifted, stories of Rush's untiring devotion to his
patients while other physicians were fleeing the city made him a popular
hero. Nonetheless, a number of his professional colleagues and a few
lay persons accused him of applying his therapy indiscriminately and
excessively. His continued use of his therapy in later yellow fever
epidemics excited such antagonism between him and the College of Physicians
that he ultimately resigned from the body and nearly left Philadelphia
for New York. Rush also made a number of professional enemies when he
defended unpopular theories on the origins and transmission of disease.
His insistence that yellow fever arose from putrid matter left in the
open rather than from contagion angered many proud Philadelphians.

As
Rush continued practicing, teaching, advocating social reforms, and
writing after the yellow fever epidemic, his renown grew at an increasing
rate. From 1797 to 1813, he served as Treasurer of the U.S. Mint. Rush's
interest in the medical relationship between mind and body resulted
in the 1812 publication of Medical Inquiries and Observations upon
the Diseases of the Mind, which was reprinted four times by 1835.
The work was the first American text on the subject and secured Rush's
position as "father of American psychiatry". While studying
psychiatry, Rush devised two curious instruments, the gyrator, based
on the principle of centrifugal action to increase cerebral circulation,
and the tranquilizer, "to obviate these evils of the 'strait waistcoat'
and at the same time to obtain all the benefit of coercion". These
instruments provided a form of shock therapy, which was interpreted
as effecting cures according to his theory involving nervous states.

In the spring of 1813, Rush fell ill with a fever and died five days
later in his home in Philadelphia. A firm believer in his therapeutic
approach, Rush had himself bled twice during his final illness. He was
eulogized by Thomas Jefferson and John Adams, among others. Rush's wife,
Julia Stockton, daughter of Richard Stockton, a judge and co-signer
of the Declaration of Independence, survived him, as did his three daughters
and six sons. His four other children had died in infancy.

Writing prolifically for nearly half a century, Rush was the first
American physician to become widely known at home and abroad. By challenging
the complex nosology (a branch of medicine that deals with the classification
of diseases) of the day, Rush moved medicine toward diagnoses and treatment
regiments that were more comprehensible and manageable. His stature
elevated the study of medicine in the United States and his position
as educator gave him far-reaching influence in the American medical
profession. Rush was also one of the first to promote the study of veterinary
medicine in North America.

Rush's professional and political prominence brought attention to his
social reforms. His lifelong stance against slavery, including his participation
in and later presidency of the Pennsylvania Society for Promoting the
Abolition of Slavery, helped free many slaves. Rush also deemed public
punishments, then common, to be counterproductive, proposing private
confinement, labor, solitude, and religious instruction for criminals.
His outspoken opposition to capital punishment contributed to the Pennsylvania
legislature's decision to abolish the death penalty for all crimes other
than first-degree murder.

By the late nineteenth century, harsh views of Rush as a benighted
blood-letter and enemy of Washington were giving way to favorable reappraisals
of his contributions to medicine and politics. In 1904, the Rush Monument,
a heroic bronze statue, was erected on the grounds of the U.S. Naval
Museum of Hygiene and Medical School in Washington by the American Medical
Association to honor the memory of the famous physician.